UNIT NINE: UNDERSTANDING & PREVENTING SEXUALLY TRANSMITTED INFECTIONS OVERVIEW SEXUALLY TRANSMITTED INFECTIONS REPORTS STI BASICS WATCH OUT! HOW TO PREVENT STIs Overview When compared to the other industrialized countries, the United States has the highest sexually transmitted infection (STI) rate. Most Americans never consider that they could be infected, even though at least one in four Americans will contract an STI at some point in his or her life. Teens and young adults account for two-thirds of all the STIs. Infections caused by sexual contact can cause symptoms that range from minor irritation to painful lesions to bleeding and pain. Some STIs have reproductive and life threatening consequences. This unit focused on seven of the most common STIs, but there are 25 others that we do not discuss. You need to be aware that all sexually active people who have multiple partners or do not use condoms are at a high risk for contracting an STI. Prevention is the key to sexual health. Safer Sex Message - abstinence, the importance of a committed relationship, limiting partners, condom use and regular health care. If you feel that you are responsible for your own health and behavior and are provided with appropriate teen-friendly resources, we can make progress in stopping the spread of STIs. Sexually Transmitted Infections Reports Purpose: To learn the basic facts about sexually transmitted infections (STIs) Step I: Divide into 6 or 7 groups and each group one STIs You will have 45 minutes to research and prepare a 5-10 minute presentation for the rest of the group about the STI you were assigned. You can use the STI fact sheets for your presentations, but you can also find very good information on the internet. Students should develop presentations that are engaging, informative, and accurate. You can do part of the research as a homework assignment if desired. Syphilis Syphilis is caused by a bacteria. Syphilis can be very serious, even deadly, if left untreated. Modern health care and screening methods almost always detect the infection before it progresses enough to be fatal. It is the least prevalent of the STIs in the US. It is passed from person to person during vaginal, anal, and oral intercourse with someone who has syphilis. The incubation time for syphilis is from 10 days to three months. The average incubation period is 21 days. Symptoms First stage symptoms: appear 10-90 days after having sex a painless, reddish-brown sore (a chancre) on the mouth or sex organs, lasting 2-6 weeks sore goes away, but syphilis is still present Second stage symptoms: develop 17 days to 6.5 months after infection and lasts 2-6 weeks a rash anywhere on the body flu-like symptoms rash and flu-like feelings disappear, but syphilis is still present Latent stage symptoms: no symptoms, but 25% of those infected may have relapse of second stage symptoms may last 30+ years after infection Late stage symptoms: may occur 1 2 years after onset of infection or 30 40 years later ulcers or gummas (soft, rubbery tumors) form on internal organs brain damage can result in insanity or death in 15-20% of people in this late stage If a sore is present, the clinician obtains some fluid from the sore and examines it. There is also a blood test for syphilis. Positive test results can occur 7 days after a sore appears. The disease can incubate from 10-90 days so there is not always a positive test result. Antibiotics by injection or taken orally You can give syphilis to your sexual partner(s) A mother with syphilis can give it to her baby during pregnancy, causing serious problems or death Heart disease, brain damage, blindness and death may result Genital Warts (HPV) Genital warts are caused by the human papilloma virus (HPV). About 750,000 new cases of genital warts are diagnosed each year in the United States. Currently it is estimated that 4 million Americans have genital warts. HPV is the most common sexually transmitted disease. Spread by skin to skin contact or during vaginal, anal, and oral intercourse with someone who has genital warts. Some people have no visible warts, but can still infect their partner(s) because they carry the virus in their skin cells. Symptoms usually show up 1 9 months after having sex, but can take even longer in some cases. 1
Symptoms include: Symptoms small bumps (warts) in the genital area or upper thighs, sometimes occurring in clusters like cauliflower the warts may go away by themselves, but this usually takes several months the warts are the color of your skin and are painless; there may be an itching sensation when they are growing Some HPV infections are asymptomatic (do not cause visible warts) Genital warts are diagnosed visually or with a PAP smear. A PAP smear is recommended for all sexually active women because HPV can cause cellular changes of the cervix. There are no tests to diagnose asymptomatic infections. Treatment of genital warts involves removal of skin cells that contain virus particles. The most common treatment is an acidic solution applied to the warts by a clinician. Removal of genital warts sometimes requires several treatments over a period of a few months. More serious warts can be treated by freezing, laser, or surgery. Genital warts can recur after they have been removed. There is no treatment for the virus itself. You can give genital warts to your sexual partner(s) HPV is associated with cervical cancer in women Prevention Gardasil HPV Vaccine Prevents 4 HPV types: 16 & 18 (high risk) and 6 & 11 (low risk) Prevents 70% of cervical cancer and 50% of external warts Given by 3 injections over 6 months Recommended for females ages 9-26 Herpes Herpes Simplex is a virus estimated to affect 45 million people in the United States. One out of five adolescents has herpes infection. Spread by skin to skin contact or during vaginal, anal, and oral intercourse with someone who has herpes [Note: In addition, oral herpes (cold sores on the mouth) can be spread by kissing or other casual contact. This virus can then be spread to the genitals during oral sex.] Symptoms show up 2 30 days after having sex, with the average being 6 days. Some herpes infections are without symptoms. Symptoms Symptoms range from mild to severe. flu-like feelings; swollen lymph nodes in groin itching or burning before the sores appear small, painful sores on the sex organs or mouth sores last an average of 10 days sores go away, but herpes is still present and sores often reoccur To test for genital herpes, a clinician swabs some of the fluid and cells from the sore. The culture is then sent to a laboratory. Blood tests can detect antibodies to the herpes virus six weeks after exposure. There is no cure for herpes, but anti-viral medication can lessen the severity and duration of the first and subsequent outbreaks and may prevent the frequency of outbreaks in some people. Medication will not cure the disease. You can give herpes to your sexual partner(s) A mother with herpes can give it to her baby during childbirth and therefore must have a cesarean section if she has an active sore at the time of labor Gonorrhea Gonorrhea is caused by a bacteria Considered the oldest and one of the most common of the STIs (first reported in 1879). It is estimated that about 700,000 new cases occur each year with the largest infection rates among teens and young adults. Gonorrhea is spread during vaginal, anal, and oral intercourse with someone who has gonorrhea. If symptoms occur, they often show up 2 10 days after having sex. Symptoms: Most women and some men with gonorrhea have no symptoms. Symptoms for women include: unusually heavy discharge from the vagina burning or pain during urination bleeding between periods cramps and pain in the lower abdomen Symptoms for men include: thick yellow or white drip from the penis burning or pain during urination swollen testicles NOTE: Both men and women with gonorrhea in the throat will complain of a sore throat that doesn t go away. To test for gonorrhea, a clinician uses a swab to remove cells from the cervix in women and the urethra in men. The culture is then sent to a lab. Gonorrhea is treated with antibiotics by injection or antibiotics taken orally, as prescribed by a health care provider. If gonorrhea is not treated: You can give gonorrhea to your sexual partner(s) A more serious infection can occur, possibly damaging reproductive organs Both men and women may no longer be able to have children A mother with gonorrhea can give it to her baby during childbirth, causing blindness 2
Chlamydia It is caused by a bacteria In 2001, 783,000 cases were reported but it is estimated that another 2 million people are unknowingly infected with chlamydia. It is the most common sexually transmitted bacterial infection and is the leading cause of preventable infertility and ectopic (tubal) pregnancy. Chlamydia is spread during sex with someone who has Chlamydia. If symptoms occur, they usually show up 1 2 weeks after having sex. Symptoms Most women and some men with Chlamydia have no symptoms Symptoms for women include: unusually heavy discharge from the vagina bleeding from the vagina between periods burning or pain during urination pain in abdomen (sometimes with fever and nausea) Symptoms for men include: watery, white drip from penis burning or pain during urination To test for Chlamydia, a clinician uses a swab to remove cells from the cervix in women and the urethra in men. The culture is then sent to the lab. Chlamydia is treated with antibiotics taken orally, as prescribed by a health care provider. You can give Chlamydia to your sexual partner(s) A more serious infection can occur, possibly damaging reproductive organs Both men and women may no longer be able to have children A mother with Chlamydia can give it to her baby during childbirth, causing blindness Hepatitis B It an infection of the liver caused by a virus. Most infected people get well, but sometimes Hepatitis B can lead to liver cancer and death. In 2001, an estimated 78,000 people in the United States were infected with Hepatitis B. The Hepatitis B virus lives in body fluids, such as: blood, semen, vaginal fluid, and saliva. Hepatitis B spreads easily from person to person through these body fluids. You can get it by: Having vaginal, anal, or oral sex with someone who has the virus Sharing needles ear-piercing, tattoo, and injection drug needles can all spread the virus Being born to a mother who has the virus in her body Symptoms of Hepatitis B include: Yellow skin or eyes Joint pain Feeling very tired Dark urine Fever Skin rash Loss of appetite Weight loss Stomach pain Liver pain Nausea and vomiting (upper right side of belly, just below rib cage) Swollen glands No symptoms A simple blood test can tell if you have hepatitis B now or have had it in the past. Some people have no symptoms, so getting tested is important. There is no cure for hepatitis B. HBV vaccination is recommended. This vaccination is given in three shots over a 6-month period and will protect you from infection if exposed to the virus. If you are exposed to hepatitis B and have not been vaccinated, you can get a special shot right away to help you. You will also be vaccinated at that time. What happens if you don t get tested? Some people who get hepatitis B may get well on their own. Others may get well but still have the virus in their bodies. Even though they feel fine, they can pass the virus on to others. Sometimes the virus can damage the liver and lead to liver cancer or death. Other viral illnesses involving the liver are also sexually transmitted. Hepatitis C: Spread by blood to blood contact and thus can be spread sexually. 70-85% of people infected with Hepatitis C may develop long-term infection and chronic liver disease. There is no vaccine for Hepatitis C. HIV/AIDS HIV (Human Immunodeficiency Virus) is a virus that attacks the immune system, leaving the body unable to fight infections. AIDS (Acquired Immune Deficiency Syndrome) is the end stage of progressive HIV disease. An AIDS diagnosis is given when a person s immune system is so damaged by HIV that the number of infection fighting cells (T-cells) falls below 200 per cubic cm of blood, or when a person is diagnosed with a disease that indicates that the immune system is severely damaged. How do you get it? In HIV-infected persons, the body fluids with the highest concentration of HIV are: blood, semen, (including pre-ejaculatory fluids) vaginal fluids, and breast milk. When one of these fluids from an HIV-infected person finds its way into the blood supply of another person, HIV infection may occur. HIV can be transmitted through the following activities: Anal, vaginal, or oral intercourse with an HIV-infected person without a condom Sharing needles with an HIV-infected person Pregnancy, childbirth, and breast-feeding, from mother to child 3
There really is no incubation period with HIV infection. The immune system of people with HIV, for the most part, is under attack from the point of infection. Symptoms of serious illness may not show up for many years. Symptoms There are no standard symptoms for HIV infections. The point of infection in some people may be accompanied by flu-like symptoms. These may include yeast infections, severe skin sores, pneumonia and cervical cancer. HIV testing and diagnosis There are three kinds of HIV antibody tests for diagnosing HIV infection. The original blood test, the Orasure test using a swab to collect cells from a person s gums and OraQuick using a finger stick drop of blood with results available in 1 hour (a confirmatory test can be obtained in 1-2 weeks for positive OraQuick results). Since it takes three to six months for an HIV-infected person to develop antibodies, people who have participated in behavior that placed them at risk for HIV infection should be tested three to six months after their most recent high-risk behavior to obtain an accurate HIV antibody test reading. There is currently no cure for HIV infection. However, there have been huge advances in the treatment of HIV, but there are drawbacks to these advances: Not all HIV infected people can tolerate the side effects of these medications. Some do not have access to these medications because of cost; while still others, because they are not able to maintain the rigorous drug regimen, go on to develop drug-resistant strains of HIV. The advances made in the treatment of HIV make early diagnosis very important. STI Basics Purpose: This activity reinforces the information students learned in the sexually transmitted infection reports. Directions: I will pass out the STI Basics cards. Take a few moments to review your cards Please place the card(s) under the appropriate infection to the best of your ability. Discussion What similarities do you notice across the different sexually transmitted infections? What are some important differences to remember? Based on this information, what are the two best ways to reduce your chance of getting a sexually transmitted infection? Watch Out! How to Prevent STIs Purpose: This activity is designed to focus on strategies that minimize the risk of contact with common STIs. The activity utilizes multiple senses and challenges students to learn in different ways. This activity is conducted as a part of the STI outreach workshop, making it important for peer educators to experience first-hand. 4
Directions: Step I: Divide into two groups, with one advisor with each group. Place the sign, What does this have to do with preventing STIs? in the middle of the circle. Place the deck of Watch Out! Cards face down next to the sign and have a student draw a card. Ask him/her to look at the card and consider the question: What does this have to do with preventing STIs? Step III: Students should consider the symbol on the card and comment on what the symbol represents in terms of preventing STIs and places the card face up in the middle of the circle. Step IV: Repeat steps I and II until all cards have been discussed. Linked chain When you engage in sexual activity with someone, it is like having sex with all of his/her previous partners. To decrease the spread of STIs, limit your number of partners to reduce your chances of exposure and know your partner s sexual history and disease status. What questions could you ask your partner to find out about his/her sexual history? Flashlight Look before you leap. It is important to notice any rashes, bumps or sores on your partner s genitals before having sexual contact because some infections are transmitted by skin to skin contact. What should you do if you notice something? Note: Shed light on the relationship. Make sure both of you are ready for sexual behavior and that you both understand the potential emotional and physical consequences. No Alcohol Alcohol lowers your inhibitions. What are possible consequences of being under the influence when you re having sex? No Syringe Sharing intravenous (IV) needles increases the chance of direct blood-to-blood transmission of HIV and syphilis. Drug use can impair judgment and may have an impact on whether or not protection is used. Why is it important to avoid sexual contact with an IV drug user? Stethoscope It is important to have regular check-ups, especially if you are sexually active. Ask your health care provider to test for STIs, since they are not routinely done. Do not assume that if you have a physical for sports, or had blood tests done, that STI testing was done. If you are sexually active, when and how often should you be tested? Are there any immunizations against STIs? Cell phone Communication is an essential part of any relationship, especially when you are sexually involved. What should you talk about? What if you find out you have an STI? Clock Give your relationships time. The more you know about your partner and his/her sexual history, the less likely you are to be exposed to an STI. The clock is also a reminder of the difference in incubation periods among the STIs. Some symptoms show up after a short period of time, others take much longer and some have no symptoms. So it is possible that your partner doesn t know s/he has an infection What else can you gain if you give more time to a relationship? 5
Lips Kissing is considered a very safe sexual behavior. It is possible to pass oral herpes by kissing, so ask your partner if he/she gets recurring sores on his/her mouth. Oral sex can transmit STIs, especially herpes, from mouth to genitals. Chlamydia and Gonorrhea can be passed from the genitals to the throat. What else can the lips/mouth represent? Condom It is essential to use protection with every sexual contact. A latex condom is one of the best ways to avoid getting most STIs. The condom must be put on before contact and removed and disposed of immediately after ejaculation. For oral sex, latex barriers (a condom for a male and a dental dam placed over the vulva for a female) can be used for protection. What STIs are best prevented by condoms? What STI s are less likely to be prevented by condoms? Hearts There are many ways of expressing affection and love that are free from the risk of STIs (hugging, holding hands, talking, etc.). It is important to remember that abstinence from sexual contact is the best way to avoid exposure to an STI. If you care about your partner you would never put them at risk for an STI. Why is abstinence from oral, anal and vaginal intercourse not 100% effective in avoiding STIs? 6